| National Provider Identifier [NPI]: | 1588729065 |
| Last Name Of The Provider | WOLDEMICHAEL |
| First Name Of The Provider | GHEBRU |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2851 S AVE B |
| Street Address 2 Of The Provider | SUITE 2601 |
| City Of The Provider | YUMA |
| Zip Code Of The Provider | 853647726 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 2930 |
| Number Of Medicare Beneficiaries | 761 |
| Total Submitted Charge Amount | 855698.86 |
| Total Medicare Allowed Amount | 377635.1 |
| Total Medicare Payment Amount | 278546 |
| Total Medicare Standardized Payment Amount | 281875.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 485 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 95430.27 |
| Total Drug Medicare AllowedAmount | 42066.38 |
| Total Drug Medicare PaymentAmount | 32608.15 |
| Total Drug Medicare Standardized Payment Amount | 32608.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 2445 |
| Number Of Medicare Beneficiaries With Medical Services | 761 |
| Total Medical Submitted Charge Amount | 760268.59 |
| Total Medical Medicare Allowed Amount | 335568.72 |
| Total Medical Medicare Payment Amount | 245937.85 |
| Total Medical Medicare Standardized Payment Amount | 249267.73 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 271 |
| Number Of Beneficiaries Age 75 to 84 | 313 |
| Number Of Beneficiaries Age Greater 84 | 119 |
| Number Of Female Beneficiaries | 151 |
| Number Of Male Beneficiaries | 610 |
| Number Of Non Hispanic White Beneficiaries | 481 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 251 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 561 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 200 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3285 |